In heart failure the heart cannot pump enough blood for the body's needs, or it can only do it at high filling pressure. Fluid backs up into the lungs and the legs.
Key symptoms
- Shortness of breath on exertion, then at rest
- Breathless lying flat; waking up gasping at night
- Leg and ankle swelling, weight gain over days
- Fatigue and less exercise tolerance
- Cough at night
What you find on exam
- Fast heart rate; low or high blood pressure
- Raised jugular venous pressure
- Crackles at the lung bases
- Extra heart sound (S3) and a displaced apex beat
- Pitting edema of the legs or sacrum
Tests
- BNP or NT-proBNP: high supports heart failure
- Echocardiogram: measures the ejection fraction and valves
- Chest X-ray: big heart, fluid in the lungs
- ECG, kidney function, electrolytes, blood count, thyroid
Treatment basics
- Diuretics to remove extra fluid; daily weights
- For reduced ejection fraction: medicines proven to help survival, started and adjusted by the clinician
- Limit salt, treat the cause (blood pressure, coronary disease, valves, alcohol)
- Teach warning signs: weight up 2 to 3 pounds in a day or 5 in a week, more breathlessness
Red flags
- Breathless at rest or cannot lie down
- Low blood pressure, confusion, cold skin
- Chest pain or new arrhythmia
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.